Provider Demographics
NPI:1881169522
Name:48TH SEAN KIMS CHIROPRACTIC PC
Entity type:Organization
Organization Name:48TH SEAN KIMS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-562-5405
Mailing Address - Street 1:39 MINEOLA BLVD STE 2I
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4278
Mailing Address - Country:US
Mailing Address - Phone:201-562-5405
Mailing Address - Fax:
Practice Address - Street 1:39 MINEOLA BLVD STE 2I
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4278
Practice Address - Country:US
Practice Address - Phone:201-562-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty